The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 03, 2011 #4,322 Publisher-Barry Block, DPM, JD

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Greenbrier Coding & Practice Management Workshop

Earlybird Discount Extended Until 12/3/11

Due to a technical website issue on Thursday morning, we have extended the $100 discount through Saturday evening. For further information, you can can click here.    

Braces Can Prevent Falls in the Elderly: OH Podiatrist 

Moore Balance Brace

Early Charcot Diagnosis Can Prevent Amputations: CA Podiatrist

When considering a Charcot foot diagnosis, clinicians should look for a red, hot, swollen foot, says podiatrist Dr. Lee Rogers, Co-Director of the Amputation Prevention Center at Valley Presbyterian Hospital. The Charcot foot can be so hot that physicians will observe a palpable difference between extremities as high as 10° F. "A difference between feet greater than 4° F with a dermal thermometer is considered significant for inflammation," says Rogers. 

Dr. Lee Rogers

"Early diagnosis is the most important way to prevent complete destruction and amputation of the foot. If a foot is diagnosed by deformity, damage within the foot has already occurred, placing patients at risk for amputation. Imaging should support the clinical diagnosis. The first diagnostic test should be a plain x-ray, which in many cases is enough to make an accurate diagnosis. If osteomyelitis is thought to co-exist with the Charcot foot, advanced imaging with an MRI or bone scan should be used," says Rogers.

Source: Physician's Weekly [12/1/11]

HHS Extends a Meaningful-Use Deadline

HHS has extended until 2014 the compliance date for Stage 2 meaningful use for those hospitals, physicians, and other eligible professionals who qualify as Stage 1 meaningful users in 2011. The announced rollback came in an HHS news release about a visit by HHS Secretary Kathleen Sebelius to Cuyahoga Community College in Cleveland to discuss health information technology's role in job creation.

Under the current rules for the Medicare portion of the electronic health-record system incentive program created under the American Recovery and Reinvestment Act of 2009, hospitals, doctors, and other eligible professionals who qualified for incentive payments as Stage 1 meaningful users in 2011—the program's first year—would have to meet new and expectedly more stringent Stage 2 standards in 2013. According to HHS' statement, if those providers had delayed participation until 2012, "they could wait to meet these new (Stage 2) standards until 2014 and still be eligible for the same incentive payment."

Source: Joseph Conn, Modern Healthcare [11/30/11]

Query: Terbinafine Overdose

My patient is a 45 year old female who took 60 terbinafine 250mg tablets in a 20-day period. I typically give the patients an initital prescription for 30 pills, redo the liver enzyme tests, and then give a second prescription for 60 pills. So instead of taking one pill per day for 60 days, she took 3 pills a day for 20 days.

I did not find out about this until 5 weeks afterwards, when she came in for a follow-up visit. I've ordered liver enzyme tests and a metabolic panel, but the patient seems to have suffered no ill effects as of yet. Unfortunately, her onychomycosis didn't go away. Anyone know if I can safely give her more pills (and better instructions)?

Eric Edelman, DPM, Syracuse, NY

Query: L1971 Pre-Fab AFO 

Has anyone billed L1971 (ankle foot orthosis, plastic, or other material with ankle joint, pre-fabricated) to Medicare? If so, what is the Medicare fee allowance for this device? We have used other similar codes (L1960 and L1970) for the Ritchie and Arizona braces, but never this pre-fabricated one.

Mark Goldberg, DPM, Chestertown, MD
 
Response: All related reimbursement policy and fee schedule material can be found on your DME MAC website. One should note that many private third-party payers which carve out custom fabricated devices to podiatrists, may reimburse your practice for a pre-fabricated device. Certainly, one should query the carrier on this matter prior to dispensing the device.

From a clinical perspective, one should be sure that your patient can utilize this type of device. In some cases, the uprights are heat-moldable as is the foot plate, thus allowing you to conform its use to a wider patient population. Other pre-fabricated devices with carbon graphite-type uprights do not have this property and, therefore, either do not benefit the patient or cause harm. One may be wise to stick with those devices which can be heat-moldable, especially with pre-fabricated devices.

Paul Kesselman, DPM, Woodside, NY

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RE: Life-Long Maintenance Regimen for Onychomycosis (Jay Kerner, DPM)
From: Evan Meltzer, DPM

Since onychomycosis starts with tinea pedis, prevention of re-infection of the nail should be aimed at preventing recurrence of tinea pedis. After successful treatment of onychomycosis with oral agents, I recommend disinfection of all footgear (quick shot of Lysol spray in each shoe, seal all in plastic bag x 24 hours - this also works for wart disinfection).  My prophylactic recommendation is to have the patient apply anti-fungal foot powder in their shoes daily thereafter for life.

Evan Meltzer, DPM, Jackson, MS

RE: Dealing with Specialist Who Refuses to Send Consultation Report (Eliot Udell, DPM)
From: Jeanne M. Arnold, DPM

I think that, in this situation, I would just call and request a copy of the patient's chart notes rather than a formal written report. Surely, this specialist must have some type of patient records and should be able to easily have his staff fax the notes to you. We have done this successfully in the past. 

Jeanne M. Arnold, DPM, Coeur d'Alene, ID, jarnolddpm3@frontier.com

RE: DB Consultants and 5010 (Charles M. Langman, DPM)
From: David Gurvis, DPM

I use DB Consultants and have for years. I have just installed my update with the 5010 programming and will be setting up the files for electronic sending to Gateway, my interchange. It will take some changes in formatting but, after that, it should be fine until the government makes further changes.
 
I got my updated disc last week. Yours should hopefully be in the mail soon. In any event, I am given to understand that the implementation date has been pushed back to March. I'm sure you can reach DB Consultants and see where you stand in line for the update.
 
David Gurvis, DPM, Avon, IN, deg1@comcast.net

RE: Who Gets to Cast
From: Gino Scartozzi, DPM

As a first year podiatry student, I heard Tom Sgarlato say in an inspiring guest lecture that it takes 100 casts before you know what you’re doing. After all these years, I would disagree. It takes 200 before you even know what you are doing wrong! The impression cast is the most crucial part of the biomechanical process. The value received by the patients for the hundreds of dollars that they spend is in the expertise to get the cast right.   

If you are only doing 4 degree rear foot posts and don’t really spend quality time in a biomechanical/gait assessment, then I suppose that having an assistant cast is acceptable. If you are really interested in obtaining a positive outcome, and take pride in the orthotics you dispense, then think about the differences in each foot as identified via exam, and translate that to the cast and to the orthotic prescription. 

Howard Dananberg, DPM, Bedford, NH, howiedbpg@aol.com

There are many reasons that come to mind why the casting process for orthoses should be performed by the practitioner. There are also important considerations as to what methods of casting one should be using to ensure patient compliance, recovery, and patient satisfaction.

First, these devices have the potential costs in the hundreds of dollars to either the insurance company or the patient if these services are not covered as a benefit. I would venture to bet that the patient would expect the doctor to perform such a service (especially when paid for by the patient) than delegating it to an assistant no matter "how well trained" in the casting process that individual is. An orthotic "failure" for a patient can happen in a small percentage of cases, even in the best of hands with proper casting techniques. Devices, on some occasions, require modifications or adjustments.

However, if such a failure occurs and is not rectified, I guarantee that...

Editor's note: Dr. Scartozzi's extended-length letter can be read here.

RE: Who Gets to Cast (Robert Scott Steinberg, DPM)
From: Doug Richie, DPM

As a practicing clinician and someone who has spent years teaching fellow practitioners and podiatric assistants the art of neutral suspension casting technique for custom foot orthoses and ankle foot orthoses, I have a few observations. While many practitioners take time to fabricate accurate casts of their patients, many do not. One only needs to visit a busy podiatric foot orthotics laboratory and see the daily shipment of casts sent in for fabrication of custom foot orthoses and they would be surprised, if not shocked, by the lack of consistency and quality. 

Furthermore, if one were to view the prescriptions accompanying the submitted casts, they would quickly see that few have any information about the range of motion, gait cycle observations, and biomechanical exam results which Dr. Steinberg correctly believes are necessary for the final correction criteria of the fabrication of the custom orthotic device.  

While this information is critical for the prescription process, the casting of the custom foot orthosis or ankle-foot orthosis can be accomplished by any individual who wants to take the time necessary to be trained in the art. I have been impressed by the enthusiasm and skills displayed by podiatric assistants who have attended casting workshops provided by Jeff Root and myself at APMA meetings and ACFAOM meetings.  

In the end, they can produce a quality cast which can be equivalent to that of their podiatric physician supervisor. As long as the cast is inspected and approved by the podiatric physician, I have no problem with accepting a quality cast from an assistant who understands and practices the essentials of the neutral suspension casting technique.
 
Doug Richie, DPM, Seal Beach, CA, drichiejr@aol.com

RE: OH Podiatrist Lauds Cosmetic Adhesive That Disguishes a Lost Toenail
From: Jerry Peterson, DPM

Could PM News post for its readers more information on Maria Barile so we can contact her regarding her product. I think we all have many patients who would be interested in applying a fake nail as I have been asked many times over the years, but was not aware of any adhesive that would not be potentially hazardous to the skin and still adhere the nail adequately.
 
Jerry Peterson, DPM, Wess Linn, OR, DRP@ifixft.com

Editor's response: For more information, or to see a one-minute video of how the product works, check Barile's site, appealingwhilehealing.com or email her at nailcreations1@gmail.com.

ASSOCIATE POSITION - TEXAS

We are looking for a reliable and enterprising podiatrist who will assist in growing our practice. People skills, clinical/surgical skills and good behavior will be a plus also Texas license required. forward your CV to "divinefootcarecenter@yahoo.com or you can also contact us at 972-790-2800, fax number 972-790-2803. 

PART TIME PODIATRIST NEEDED- LOS ANGELES, CALIFORNIA
 
Busy podiatrist looking for assistance with treating home-bound patients. Flexible hours, independence, and great compensation. If interested, email CV to homefootcare@hotmail.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA - SAVANNAH

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV)to northtexaspodiatry@yahoo.com along with a letter of intent

ASSOCIATE POSITION - MARYLAND

Multi-office group seeks highly trained surgical associate to join us. Prefer person with frame and trauma experience. Our practice is state-of-the-art and has all modalities: EMR, PadNnet, on-site billing, diagnostic US, PRP, digital x-ray, etc. Excellent salary, bonus structure and benefits with partnership available. Please forward CV and letter of intent to docsbnb@aol.com

ASSOCIATE POSITION - TAMPA BAY AREA

Excellent opportunity to join a well-established multi-office group practice in the beautiful Tampa Bay area starting July 1, 2012. We are seeking a highly motivated, ethical and personable physician with a Florida license. Competitive salary, excellent benefits and partnership track. Please email or fax CV to thesykeshome@aol.com (813) 254-8262

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977 Diane Coulter, Office Manager.

ASSOCIATE POSITION – NORTHERN CALIFORNIA / BAY AREA

We’re looking for someone entrepreneurial who can help grow our practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. Send your CV and cover letter to cvpodiatrist@gmail.com

ASSOCIATE POSITION - BRONX, NY

Excellent hospital-based opportunity. Outpatient Care in busy clinic. Large diabetic population. Competitive salary and benefit package. Email CV and letter of interest to nealblitz@gmail.com

PODIATRY OFFICE TO SHARE - SEATTLE, WASHINGTON

Fully equipped podiatry office in North Gate area of Seattle. Office located in medical professional building near I-5. Office has 3 treatment rooms, 3 physical therapy rooms, direct digital x-ray, PAD- net, NCV testing equipment, physical therapy equipment. Please contact us: website Tel. 425-643-8901isbinc2006@gmail.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER (LUMIX2)

Superpulse 45 watt peak power Laser (lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPMfootcare@comcast.net

EQUIPMENT FOR SALE - CLASS FOUR LASER- USED K-LASERS

I have used K-laser for sale. Still in Warranty. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargeable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net 

PM News Classified Ads Reach over 13,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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